Developing Assessments and Interventions for Phantom Limb Pain in Veterans with Amputations

制定针对截肢退伍军人幻肢痛的评估和干预措施

• 批准号: 10066197
• 负责人: Tonya L Rich
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10066197
• 关键词: Affect; Amputation; Area; Base of the Brain; Behavioral; Body part; Brain; Brain region; Caring; Cerebral hemisphere; Clinical; Clinical Management; Clinical Trials; Community Participation; Complex; Contralateral; Data; Databases; Dependence; Diabetes Mellitus; Disease; Evaluation; Family; Frequencies; Functional Magnetic Resonance Imaging; Future; Goals; Healthcare Systems; Ice; Image; Impairment; Individual; Informatics; Information Systems; Infrastructure; Intervention; Investigation; Knowledge; Lead; Leg; Life; Life Experience; Limb structure; Location; Lower Extremity; Magnetic Resonance; Maps; Measurement; Measures; Mental Health; Methods; Minnesota; Nervous system structure; Observational Study; Opioid; Pain; Pain interference; Patient Outcomes Assessments; Pattern; Peripheral Vascular Diseases; Persistent pain; Persons; Phantom Limb Pain; Pharmacology; Population; Prosthesis; Quality of life; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Research; Resolution; Rest; Risk; Sensory; Side; Structure; Surveys; Techniques; Technology; Testing; Toes; Trauma; Treatment Effectiveness; United States Department of Veterans Affairs; Universities; Veterans; Work; arm; base; care systems; chronic pain; comorbidity; daily functioning; data warehouse; design; experience; foot; grasp; high risk; individual variation; innovation; insight; limb amputation; neuroimaging; neuroregulation; non-healing wounds; novel; pain patient; painful neuropathy; personalized medicine; prescription opioid; primary outcome; programs; residual limb; secondary outcome; sensory discrimination; success; therapy design; tool; treatment response

Phantom limb pain (PLP) significantly impairs rehabilitation outcomes and community participation for Veterans with lower limb amputations. PLP is a form of neuropathic pain, where damage or disease affects the nervous system causing uncontrolled pain. Prior neuroimaging research suggests that brain- based changes following amputation contribute to PLP. Changes previously documented include decreased sensory representation of the amputated limb (i.e. sensory map changes) and decreased connectivity between structures. With advancements in neuroimaging, we can now study brain-based changes in persons with lower limb amputations thus informing the design of novel rehabilitation interventions. The objective of this project is to investigate brain-based changes following lower limb amputation to identify neurocorrelates of PLP. There is growing evidence supporting the efficacy of neuromodulation as a non-pharmacological technique for chronic pain including PLP. Neuromodulation is a family of techniques that utilize electrical input to modulate the activity of a region of the brain and includes techniques such as non-invasive brain stimulation (NIBS). By pairing NIBS with existing rehabilitation techniques known to be effective for some with PLP, we can target brain-based changes to reduce PLP. Although there is preliminary evidence of neuroimaging and neuromodulation for PLP, this is unstudied in the Veteran population. Through the Veteran’s Administration (VA) Corporate data warehouse using the Informatics and Computing Infrastructure (VINCI) national database, we learned that the VA Health Care System cares for 36,000 Veterans with amputations where 81% of those Veterans have prescribed opioids for pain. The complexities of post-amputation care are great especially given our Veterans have additional co- morbidities. The long-term goal of this work is to investigate combined, non-pharmacological rehabilitation intervention for PLP in Veterans to be tested with a clinical trial in a CDA-2 proposal. However, before we can investigate the effect of a combined intervention, we must first investigate neurocorrelates of PLP in the Veteran population. The aim of this proposal involves 16 Veterans (ages 18+) with unilateral transtibial amputation (8 Veterans with and 8 Veterans without PLP). First, the Veterans will be asked to complete pain patient- reported outcomes including surveys that examine how pain interferes with daily life and pain-specifics (frequency, duration, description of pain), in combination with survey questions on prosthesis wearing patterns. Second, the Veterans will participate in neuroimaging at the Center for Magnetic Resonance Research (CMRR) at our academic affiliate, the University of Minnesota. Imaging sequences will include two forms of functional magnetic resonance imaging (fMRI). The first fMRI sequence is resting- state to evaluate the connectivity of the brain activity at rest. The second fMRI sequence is a sensory task using pneumatic-driven sensory stimulation to evaluate how the brain interprets sensory information for the residual limb and contralateral limb. Altogether, this CDA-1 proposal will lead us to novel PLP interventions. We anticipate our interventions will be more effective as the design of intervention is informed by neuroimaging results. With this preliminary data, we will be prepared to design and test combined novel rehabilitation interventions for the reduction of PLP in Veterans. The VA Health Care System can lead the way in innovative, effective methods to treat PLP where in the future, non-pharmacological, PLP interventions can be personalized to the Veteran based on their clinical profile.

幻肢疼痛(PLP)严重损害康复效果和社区参与 腿部截肢的退伍军人。PLP是神经病理性疼痛的一种形式，损伤或疾病 影响神经系统，导致无法控制的疼痛。先前的神经成像研究表明，大脑- 截肢后的基础改变有助于PLP。以前记录的更改包括 截肢感觉表征减少(即感觉图改变)和减少 结构之间的连通性。随着神经成像的进步，我们现在可以研究基于大脑的 下肢截肢者的变化，从而启发了新的康复设计 干预措施。这个项目的目标是研究下肢后脑的变化。 截肢以确定PLP的神经相关性。 越来越多的证据支持神经调节作为一种非药物疗法的疗效。 治疗慢性疼痛的技术，包括PLP。神经调节是一系列利用电信号 调节大脑某一区域活动的输入，包括非侵入性等技术 脑刺激(NIBS)。通过将NIB与已知有效的现有康复技术配对 对于一些患有PLP的患者，我们可以针对基于大脑的改变来减少PLP。虽然有初步的 PLP的神经成像和神经调节的证据，这在退伍军人群体中还没有研究。 通过退伍军人管理局(VA)公司数据仓库使用信息学和 计算基础设施(Vinci)国家数据库，我们了解到退伍军人医疗保健系统关心 对于36,000名截肢的退伍军人来说，其中81%的退伍军人开了阿片类药物止痛。 截肢后护理的复杂性是巨大的，特别是考虑到我们的退伍军人有额外的 病态。这项工作的长期目标是研究联合的、非药理学的 退伍军人PLP的康复干预将通过CDA-2建议的临床试验进行测试。 然而，在我们能够调查联合干预的效果之前，我们必须首先调查 退伍军人群体中PLP的神经相关性。 这项提案的目的涉及16名退伍军人(年龄18岁以上)，接受单侧经胫骨截肢(8例 有PLP的退伍军人和8名没有PLP的退伍军人)。首先，退伍军人将被要求完成疼痛患者- 已报告的结果包括调查疼痛如何影响日常生活和疼痛细节 (频率、持续时间、疼痛描述)，以及关于佩戴假肢的调查问题 模式。其次，退伍军人将参加磁共振中心的神经成像 研究(CMRR)在我们的学术附属机构，明尼苏达大学。成像序列将 包括两种形式的功能磁共振成像(FMRI)。第一个功能磁共振成像序列正在休息- 状态以评估休息时大脑活动的连通性。第二个fMRI序列是一种感觉 使用气动感官刺激评估大脑如何解释感官的任务 残肢和对侧肢体的信息。 总之，这项CDA-1提案将引导我们进行新的PLP干预。我们期待着我们的干预 将会更有效，因为干预的设计是由神经成像结果提供信息的。有了这个 初步数据，我们将准备设计和测试组合的新型康复干预措施 退伍军人PLP的降低。退伍军人保健系统可以在创新、高效方面走在前列 治疗PLP的方法，在未来，非药物的PLP干预可以个性化 根据退伍军人的临床特征。